Cost-Utility analysis of control-IQ technology relative to conventional insulin therapy in adults with type 1 diabetes

Objective: This study evaluated the cost utility of the t:slim X2 insulin pump with Control-IQ technology (Control-IQ) relative to multiple daily injections (MDIs) and standard insulin pump therapy, both used in combination with continuous glucose monitoring (CGM), in adults with type 1 diabetes from a payer perspective in Belgium. Research Design and Methods: A lifetime cost–utility analysis was conducted using the IQVIA CORE Diabetes Model. Baseline characteristics and treatment effects were informed by the Belgian real-world, multicenter, prospective INRANGE study. Direct medical costs included treatment, complication management, and severe hypoglycemic events. Country-specific costs were based on RIZIV-INAMI data and other publicly available sources. Utility values were based on published literature and included the reduction in fear of hypoglycemia associated with Control-IQ as reported in the INRANGE study. Outcomes included quality-adjusted life years (QALYs) and incremental cost–utility ratios (ICURs). Scenario analyses explored variations in the comparator (MDI + CGM only), reduced HbA1c efficacy, and time horizon. Results: Control-IQ yielded 19.50 QALYs versus 17.92 for MDI and standard insulin pump therapy plus CGM, with total costs of €193, 588 and €160, 129, respectively, resulting in an ICUR of €21, 111/QALY. Scenario analyses confirmed robustness: MDI + CGM as sole comparator (ICUR: €41, 701/QALY), reduced HbA1c efficacy (ICUR: €25, 967/QALY), and a 20-year time horizon (ICUR: €30, 183/QALY). Conclusions: Control-IQ provides clinical benefits relative to MDI and standard insulin pump therapy plus CGM in adults with type 1 diabetes in Belgium and appears to be cost-effective in this setting, considering commonly used thresholds. These findings support the broader adoption of automated insulin delivery systems in diabetes management.